Mobile Response & Stabilization Services Peer Meeting December - - PowerPoint PPT Presentation

Mobile Response & Stabilization Services Peer Meeting

December 5-6,2017 New Brunswick, NJ Day 1

This peer small group meeting is hosted by the National Technical Assistance Network for Children’s Behavioral Health (TA Network), operated by and coordinated through the University of Maryland.

This presentation was prepared by the National Technical Assistance Network for Children’s Behavioral Health under contract with the U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Contract #HHSS280201500007C. The views, opinions, and content expressed in this presentation do not necessarily reflect the views, opinions, or policies of the Center for Mental Health Services (CMHS), the Substance Abuse and Mental Health Services Administration (SAMHSA), or the U.S. Department of Health and Human Services (HHS).

CMS/SAMHSA Joint Information Bulletin (May 2013)

Intensive Care Coordination: Wraparound Approach Parent and Youth Peer Support Services Intensive In-Home Services Respite Mobile Crisis Response and Stabilization Flex Funds Trauma Informed Systems and Evidence-Based Treatments Addressing Trauma

https://www.medicaid.gov/federal-policy-guidance/downloads/CIB-05-07-2013.pdf

MRSS Value to Systems of Care

• Quality of Life
• Resource
• Referral source
• Fiscal

Faculty/Staff Introductions

– Milwaukee County, Wisconsin:

Bruce Kamradt, Chris Morano

– New Jersey:

Elizabeth Manley, Ruby Goyal-Carkeek, Wyndee Davis, Stacy Reh, Jessica Houghton, Jennifer Holder

– Connecticut:

Tim Marshall, Adora Harizaj

– TA Network:

Dayana Simons, Rhona Mutibwa, Jamila Savage

Agenda: Day 1

• State Team Introductions
• Debrief Ride – Along with NJ Mobile Units
• Presentation of Best Practice Models
• Lunch (on your own)
• Affinity Groups
• Affinity Groups Report Out
• Q&A and Wrap Up

MRSS Resource Material Library: http://www.tanetworkmeetings.org/2017-mrss-resources

Team Introductions

• Alaska
• Colorado
• Georgia
• Indiana
• Kansas
• South Carolina
• Tennessee

8

ALASKA

Alaska

Participant Name Title/Role Organization (if applicable)

Jim McLaughlin Mental Health Clinician III Alaska Div. of Behavioral Health Kacea Bjork Mental Health Clinician III Alaska Div. of Behavioral Health Tim Brown Mental Health Clinician III Alaska Div. of Behavioral Health Charlene Tautfest Board Member Alaska Mental Health Board Christopher Byrnes BH Emergency Services Director Yukon-Kuskokwim Health Corp Paul Cornils Executive Director AK Youth & Family Network Jimael Johnson Program Officer AK Mental Health Trust Naomi Tigner John Cook Director of Community Pgms Director of Behavioral Health Presbyterian Hospitality House Mat-Su Health Services

AK Program Structure

• Currently Alaska has an incomplete and fragmented Mobile

Crisis Support System but is poised to apply to CMS for a new array of services through an 1115 Medicaid Waiver.

• The 1115 will target (along with other populations) Youth up

to age 21 who are either in state custody through the Office of Children’s Services, the Division of Juvenile Justice, are currently or formerly in foster care, or are at risk for out-of- home placement.

AK New Program Components

• Mobile Crisis Response Services
• Intervening wherever crises occur
• 23 Hour Crisis Stabilization Services
• - Psychiatric supervision, continuous nursing services
• Crisis Residential and Stabilization Services
• 24/7 psychiatric stabilization
• Peer-based Crisis Intervention Services

AK Barriers/Challenges

• Waiver will be submitted to CMS in January –

undetermined length of negotiation.

• The state BH system redesign also includes contracting

with an Administrative Services Organization (ASO) to directly manage the system

• Timing of implementation of new services across the state
• System development in rural & remote areas
• Planning for specific staffing and protocols

AK Objectives

Identify:

• Models for urban “hubs” for service array and model

fidelity

• Models for rural “hub” communities and remote

villages using distance technology and natural supports

• Ways other systems are financing mobile crisis

supports

COLORADO

Colorado

Participant Name Title/Role Organization (if applicable) Claudia Zundel Principal Investigator, COACT Colorado Colorado Department of Human Services, Office of Behavioral Health (CDHS) Mary Hoefler Manager, Crisis Services CDHS Angela Grosso Coordinator, Crisis Services CDHS Justine Miracle Medicaid System of Care Developer HCPF

CO Program Structure

Colorado Crisis Services:

• Statewide crisis program
• Administered through the Colorado Department of Human

Services (CDHS) Office of Behavioral Health Services

• Four regional contractors provide walk-in, crisis stabilization,

and respite services, and one statewide crisis hotline contractor

• Services are offered to all populations, as crisis is self-defined

to enhance accessibility

• Funding source: State general funds

CO Program Components

• Mobile crisis services are available statewide to meet

people in community-based locations

• Mobile clinicians are deployed according to the initial

assessment from a crisis line clinician

• Mobile clinicians conduct an in-person assessment

and make a determination of treatment needs and appropriate referrals and linkages to services

CO Barriers/Challenges

• Currently in year 4 of a 5-year contract
• Procurement will occur at the end of this contract for services beginning FY19
• Barriers include: Each of the 17 community mental health centers (CMHCs) has

their own crisis line – Difficulty distinguishing between mobile services being dispatched through the CMHC hotline and the crisis hotline and raises questions about the appropriate criteria for separating those services – Resistance from CMHCs/clinical staff to respond to unknown callers in the community without law enforcement present – Have not served many children including those in child welfare

CO Objectives

• Exploring the possibility of a crisis stabilization

benefit for children that could be co-financed with Medicaid

• Determining key data elements to collect and

monitor the system

• Identify key contract provisions to strengthen crisis

system

GEORGIA

Georgia

Participant Name Title/Role Organization (if applicable) Dante McKay, JD, MPA Director; Office of Children, Young Adults & Families; BH Division

• Dept. of Behavioral Health &

Developmental Disabilities Deborah Atkins, MAC, LPC Director; Crisis Coordination

• Dept. of Behavioral Health &

Developmental Disabilities Wendy White Tiegreen, MSW Director; Office of Medicaid Coordination & Health System Innovation

• Dept. of Behavioral Health &

Developmental Disabilities Maya Carter Program Specialist; Medicaid Division; Aging & Special Populations

• Dept. of Community Health

Bhavini Solanki-Vasan, LPC Director; Behavioral Health Services Amerigroup Wendy Martinez Farmer, MS, LPC CEO Behavioral Health Link Jessica Schmoll, LPC Director, Behavioral Health CareSource Kisha Whitfield, PhD CEO Integrated Concepts for Families

GA Program Structure

• Level of Support: $21.3M
• Funding:

– State: 85% – Title XIX: 15%

• Populations served: Children, young adults, adults

– Behavioral Health – Intellectual & Developmental Disabilities – Child Welfare – Juvenile Justice – Medicaid

• Agency: Dept. of Behavioral Health & Developmental Disabilities

(DBHDD)

GA Program Components

• Georgia Collaborative ASO (DBHDD)
• 24/7; 159 counties
• Crisis Call Center
• Technology/Dashboard
• Mobile Crisis Response Teams

– BH (2 providers, 6 regions) – IDD (4 providers, 6 regions)

• Crisis Stabilization (CSU, BHCC, contract beds)

GA Barriers/Challenges

• Service Gaps & Needs committee formed and began

meeting in September 2016

• RFP anticipated for January 2018
• Challenges include:

– Blending mobile response services for BH and IDD – Services/supports for dually diagnosed individuals – Coordinating care across agencies

GA Objectives

– Service Delivery Distinction

(“mobile crisis and stabilization” versus “mobile response and stabilization”)

– Emergency room and justice diversion best practices – Improved response time, coordination efficiencies, and outcomes

INDIANA

Indiana

Participant Name Title/Role Organization (if applicable)

Sirrilla D. Blackmon, LCSW, LCAC Deputy Director /Youth Services, Mental Health Promotion/Addiction Prevention Family Social Services Administration (FSSA) Division of Mental Health and Addiction Cathy Robinson Director/Bureau of Developmentally Disabilities Services FSSA-Bureau of Developmentally Disabilities Services Vivian Frazier Program Director/Child SPA and Waiver FSSA-Office of Medicaid Policy and Planning Sarah Sparks Deputy Director/Support and Services Department of Child Services Nancy Wever, LSW Acting Director, /IJDAI Juvenile Detention Alternative Initiative

IN Program Structure

• Indiana has 92 counties and 25 Certified Community Mental Health Centers

(CMHCs) that serve as the safety net for the state

• The populations served are:

– Serious Mentally Ill /Serious Emotionally Disturbed – Chronically Addicted – Dually Diagnosed

• The current array of mental health and addiction services are supported by

MH Block Grant, SA Block Grant, Medicaid and other third party payers

• Program implementation of new services will be supported through the Office
• f Medicaid and the Division of Mental Health and Addiction
• Indiana has a 1915(i) SPA for Child Mental Health/High Fidelity Wraparound

IN Program Structure (continued)

• Mental health and substance abuse issues are prevalent and relevant concerns

across all child serving agencies

– E.g. One of child welfare’s greatest concerns is access to care and qualified professional to deliver services; juvenile justice is managed at the county level and access to care is of concern; concern for Bureau of Development Disabilities is very few facilities accept children who are dually diagnosed.

• CMHCs provide the array of services across the continuum with the exception of

mobile response stabilization and support services

• The Department of Child Services utilize contractual agreements with CMHCs and
• ther providers to ensure youth involved with child welfare receive mental health

services

• Youth with behavioral health issues who are involved with Juvenile Justice access

services through DCS, services that are court ordered or receive alternative community supports

IN Program Components

• Indiana currently does not have MRSS in the array of services

being offered. – Many years ago mobile crisis services were offered for the SMI/SED population but it was not sustainable and was dropped from the service array.

• CMHCs offer 24 hour crisis services by phone and access site
• Mobile crisis services are offered on a smaller scale in different

parts of the state – funded through grants or agency (CMHC) support

IN Barriers/Challenges

• Indiana is at the beginning stages of information

gathering for upcoming procurement process.

• Potential barriers that may impede success are:

– Workforce issues – Financial structural – Cross agency implementation

IN Objectives

• Obtain information regarding program and payment

structure including blending and braiding of funds

• Gain knowledge about:

– “Lessons learned” – Implementation elements of a cross state agency collaborative model

KANSAS

Kansas

Participant Name Title/Role Organization (if applicable) Kelsee Torrez SOC Project Director Kansas Dept. for Aging & Disability Services (KDADS) Gary Henault Children’s Behavioral Health Program Manager Kansas Dept. for Aging & Disability Services (KDADS) Nicole Stafford Therapist/Intensive Outpatient Program Manager/SOC Project Coordinator Parent, Adolescent & Child Empowerment Services (PACES) Vicki Broz Program Director Compass Behavioral Health

KS Program Structure

• There are 26 community mental health centers (CMHCs) in

Kansas

• CMHC staff are available 24/7 for crisis calls and to assess for

hospitalization

• CMHCs serve anyone in their catchment area; SOC youth are

ages birth-21, with SED, mostly school aged, residing within 16 counties.

• Some CMHCs are under the county’s jurisdiction, others are

independently operated with a Board of Directors.

• CMHCs are locally (county, state) and federally (Medicaid,

Block Grant, etc.) funded

KS Program Components

Urban:

• Parent, Adolescent & Child Empowerment Services (PACES):

emergency shelter to youth and families; co-responder who works with the Unified School District (USD) and local police department; goal is to reduce police contacts & reduce suspensions; and has identified one therapist to serve as a crisis responder for the USD. Rural/Frontier:

• Compass Behavioral Health:

4 therapists are available 24/7 for youth and families; can utilize tele-video conferencing for assessments (Medicaid reimbursable); and offers crisis housing for youth.

KS Barriers/Challenges

• Creating a unified plan for Kansas.

– Each catchment area has unique needs (urban, rural, frontier).

• Our team would like to improve local partnerships with child

welfare and juvenile justice. – Requires proactive planning and improved communication among partners, which can be a challenge with a strained workforce.

• We are interested in a non-crisis mobile response strategy.

– This would require policy change, workforce development, and culture change.

KS Objectives

Top 3 objectives for this meeting:

• 1. To learn how to plan, integrate, expand and sustain a

statewide crisis and non-crisis mobile stabilization service.

• 2. How to implement care coordination and peer support

within this approach.

• 3. The process and structure of other states’ response

strategy: dispatcher, response team, leadership roles, etc.

• This is an added objective from the initial application

SOUTH CAROLINA

South Carolina

Participant Name Title/Role Organization (if applicable) Vanesha Perrin Program Manager/Team Leader for Quality Assurance South Carolina Department

• f Health and Human

Services, Division of Behavioral Health Lynelle Reavis Program Manager, Policy Management Team Leader South Carolina Department

• f Health and Human

Services, Division of Behavioral Health

SC Program Structure

Community Crisis Response and Intervention (CCRI):

• Currently 100% State funding

– Anticipate county funding once local outcomes are demonstrated

• South Carolina has a robust state agency network including DSS,

DJJ and DMH – Funded through contract with DMH – will join the monthly multi-agency stakeholder meetings regarding continuity of care

• Statewide, with a focus on customizing services to meet the needs
• f the area served.

SC Program Components

CCRI will provide:

• A 24/7 warm line staffed with individuals who have mental health and

crisis experience to field the calls to the designated local DMH clinicians

• Clinical screening in order to de-escalate the crisis and provide linkage to
• ngoing treatment and other resources. Services will be rendered in the

following modalities – In person at the location of the crisis – In person at a CMHC Clinic – Telephonically

• Statewide clinical and administrative supervision via a centralized office
• Staff to build relationships and resources with community partners

SC Barriers/Challenges

• Finding an experienced workforce for the supervisory

positions.

• Gaining support of all necessary community partners,

specifically hospitals and probate courts.

• Completing a service design for areas that lack adequate

resources has also been a barrier.

SC Objectives

To learn:

• Best practices to inform future policy decisions
• About quality and outcome measurements/indicators
• About financing strategies (beyond Medicaid) to fund

CCRI

TENNESSEE

State of Tennessee

Participant Name Title/Role Organization (if applicable)

Heather Taylor

• Dept. of Mental Health & Substance

Abuse Services Director, Office of Children & Youth Mental Health Morenike Murphy

• Dept. of Mental Health & Substance

Abuse Services Director, Office of Crisis Services and Suicide Prevention Keri Virgo Department of Mental Health and Substance Abuse Services Project Director, System of Care Across Tennessee

• Dr. Lisa Pellegrin

Department of Children’s Services Psychology Director Crystal Parker TennCare Director, Children’s Programs Ellyn Wilbur Tennessee Association of Mental Health Organizations Executive Director Melissa McGee Tennessee Commission on Children and Youth Director, Council on Children’s Mental Health Rikki Harris Tennessee Voices for Children CEO

TN Program Structure

Statewide Youth Mobile Crisis Services

• Provides statewide crisis services for children and youth under

the age of eighteen (18) years

• Emergency counselors (triage specialists) handle calls 24/7

through regional hotlines or the statewide crisis line and determine an appropriate response

• Statewide Services are provided by 4 contracted agencies
• 1. Youth Villages
• 3. Frontier Health
• 2. Mental Health Cooperative 4. Helen Ross McNabb
• State Funded (DMHSAS and TennCare)

TN Program Components

• 24/7 Hotline Triage Counselors
• Face to Face Assessments
• Telehealth Assessments (when appropriate)
• Community Referrals
• Follow-Up

TN Barriers/Challenges

• Diverting youth from the ED and helping

ensure access to available community services

• Different payor sources
• Geography
• Transportation

TN Objectives

• To walk away with an implementable, multi-agency

plan to expand crisis stabilization options for children and families in Tennessee

• To observe and connect with other states on their

high-impact, low cost crisis stabilization programming

• To learn how existing children services in Tennessee

can coordinate with youth mobile crisis

MILWAUKEE MOBILE CRISIS RESPONSE AND STABILIZATION SERVICES: FORCES AND PARTNERSHIPS DRIVING EVOLUTION

Bruce Kamradt

Administrator Emeritus, Wraparound Milwaukee

Christopher Morano

Founding Director Emeritus, MUTT

Background and History

• Mobile Response Services in Milwaukee

were developed 22 years ago as an integral component of Wraparound Milwaukee

• Wraparound Milwaukee (WM) is a

coordinated, single system of care serving Milwaukee County youth with serious emotional and mental health needs and their families across child serving systems

Background and History (cont.)

• WM is operated under the auspices of the Milwaukee

County Mental Health Board as a unique Care Management Entity(CME) with a capitated contract under WI Medicaid to plan for, provide, pay for and manage care for youth with SED and their families.

• 1670 families served in 2016
• Average daily enrollment of 1213 families

Key Service Components of WM

• Care Coordination

– utilizing a high fidelity wraparound approach

• Mobile Urgent Treatment Team(MUTT)

– 24/7 crisis response and planning

• Comprehensive Service Array

– Availability of clinical and support services delivered through provider network

• Family Support and Advocacy Organization

Evolution of MUTT Team

• MUTT began in 1995, during Year 2 of the CMHS

grant that initiated WM, as a service to children enrolled in Wraparound with the primary goals to: – keep youth and families together, – support care coordinators in crisis/ safety planning and management, – reduce ER use and – prevent need for unnecessary inpatient psychiatric care

Evolution of MUTT(cont.)

• A change in state law in 1996 required all WI counties to

plan for and provide mental health crisis services (HFS34) for adults and youth

• HFS34 created new fee-for-service funding under WI

State Medicaid program for provision of mobile crisis response and optional stabilization services. The state made MRSS a more comprehensive service

• MUTT evolved to be the designated crisis system for all

children in Milwaukee county but also retained it’s “gatekeeper” functions for WM youth.

Evolution of MUTT(cont.)

• 2002 - Crisis stabilization services including crisis group home and

crisis 1:1 stabilizers added to service array.

• 2005 - Contract with child welfare for creation of a dedicated foster

care crisis team due to excessive placement disruptions and response to federal lawsuit.

• 2006 - Contract with Milwaukee Public Schools for specialized crisis

team, grades 6-12, to respond to school aggression, suspensions, etc. (ended in 2010 due to loss of state funds).

• 2015 - MUTT/Milwaukee Police Dept. trauma team developed based
• n Yale Child Studies model of police, mental health partnership.

The Need for Mobile Response Services

• 1. Create a single point of access for children/families

experiencing a mental health crisis

• 2. Reduce over utilization of emergency room and

psychiatric inpatient care

• 3. Clinical triage/assessment for entry in WM
• 4. Reduce "secondary" placements from hospital into

residential treatment centers

Components of MUTT Service

• Telephone Service: qualified and trained staff, 24/7, providing

callers with information, support, counseling, intervention, emergency service coordination and referral. This is provided directly by MUTT staff from a central office and dedicated crisis line.

• Mobile Response Service (Mobile Urgent Treatment Team):

provides onsite, in-person intervention for persons experiencing a mental health crisis; available to make home visits and other locations in the community; staff must be qualified under state HFS34 requirements. This is provided directly by MUTT staff.

Components of MUTT (cont.)

• Walk-in Service: face to face support at an identified location;

MUTT uses psychiatric crisis service in emergency room of county psychiatric facility

• Short-term Hospitalization: MUTT maintains agreement with

the county’s child and adolescent inpatient service

• Linkage and Follow-up: connects child and family to ongoing

services (i.e. Wraparound Milwaukee)

• Stabilization Services

Crisis Stabilization Services

• Stabilization services are designed to:

– reduce or eliminate symptoms of mental illness to prevent need for inpatient hospitalization or – assist in the transition of a child to a less restrictive placement or living arrangement when the crisis has passed. An array of crisis stabilization services have been developed by WM to be used in conjunction with and under the direction of the MUTT

MUTT Crisis Stabilization Services

• Crisis/Respite Beds in Community Group Homes

– Placement up to 14 days to divert from hospitalization

• Crisis Beds in Residential Treatment Facilities (RTF)

– Crisis beds designated in a RTF for short-term placement up to 14 days (rate negotiated with RTF)

• Crisis Beds in Treatment Foster Homes

– Purchased on a case by case basis

• Peer to Peer Support

– Some done by Families United of Milwaukee via WM

MUTT Stabilization Services (cont.)

• Crisis 1:1 Stabilizers:

– Short-term service provided in the home, school and community to evaluate, manage, monitor, stabilize and support youth’s well-being and appropriate behavior consistent with their crisis plan, and to prevent another crisis from occurring

• 1:1 Crisis Stabilizers:

– Have BA/BS degree or H.S. diploma – Over 250 stabilizers (part & full-time) – Work under crisis/safety plan mostly with WM enrolled youth

Composition of Mobile Urgent Treatment Team (MUTT)

• 20 MSW social workers, 3 PhD psychologists, consulting

psychiatry services as needed

• 24/7 availability (pager from 11pm – 7am)
• Two-person teams
• Preferred provider arrangement with Milwaukee County

inpatient psychiatric unit

• Two MSWs co-located with police

– directly housed in a police station (Trauma Team)

Required Staffing for MUTT

• Program Administrator and Clinical Director

– can be the same person

• Professional staff licensed by state

– If under 3000 hours of supervised clinical experience must have one hour of supervision for every 30 clock hours of face to face time. – If over 3000 hours, one hour of peer clinical consultation for every 120 hours of face to face time is required.

• New staff have 40 hour orientation training

– 20 hours with over 6 months emergency work experience

MUTT Data

• 3000 calls to MUTT in 2016

– 916 initial cases

• 1850 face to face
• 45% of families seen in the home, 24% in schools,

10% Emergency Rooms

• 50% of referrals came in on first shift, 45% on 2nd

shift and less than 5% from 11pm to 8am

• Average response time = 20 minutes

– 241 sq. mile service area

Funding Strategies to Support MUTT

• Medicaid covers 60% of costs for mobile crisis response and

stabilization services based on performing provider hourly rates under (HFS34); Counties are expected to cover remaining costs.

• WM covers remaining costs of MUTT through through pooling funds

received from Medicaid capitation contract($1892 pmpm); case rate from CW of $114 per day (230 youth) and case rate from JJ of $80 per day (400 youth)

• $750,000 additional contract with CW for dedicated crisis service to

foster homes

• City of Milwaukee provides $90,000 contract for new MUTT/Police

Trauma Unit

• Monies saved from reduced use of psychiatric hospitalization and RTFs

are re-invested into expanding community-based services

Medicaid Coverage for Crisis Intervention in Wisconsin

• Medicaid can only pay County human service agencies or

agencies with whom they contract to provide crisis intervention services.

• Agencies must be certified under HFS34.
• Recipients being discharged from a hospital or RTF are eligible for

crisis services if they are likely to experience another crisis if these services are not provided.

• Recipients in a hospital or RTF are eligible to receive crisis services

if needed to develop a crisis plan or to facilitate transition back to their home or community.

Current WI Medicaid Fee Schedule for Crisis Service

• Psychiatrist and Advanced Practice RN

– $148.16 per hour (state reimburses federal share at 60% or $85.15 per hour)

• PhD Psychologist

– $110.23 per hour (state reimburses $63.35)

• Master degree or BA/BS

– $88.90 (state reimburses $51.09)

• Paraprofessional

– $44.00 per hour = $27.50

• Per diem for Group home/RTF

– $139.54 per day (Medicaid reimburses at $80.19 per day)

Information Technology

• Access to good data system is critical for a mobile

response team

• MUTT uses Synthesis, an electronic health record and

data system developed and used by WM

• MUTT enters data into the system for all contacts

and work with families; includes assessments, crisis plans, authorized services and providers, progress notes, etc.

Information Technology (cont.)

• Synthesis converts progress notes into billing documents

that go to Medicaid electronically

• MUTT and WM use a single release of information allowing

case data to be shared and viewed on-line

– MUTT can see care plans and crisis safety plans, care coordination notes, provider notes, etc. MUTT plans and progress notes can than be viewed by WM care coordinators. Juvenile justice also uses system.

• Internet-based IT system is needed so you are not “flying

blind” into crisis situations

Outcomes Supporting MUTT Sustainability Over 20 Years

• Reduction in utilization of inpatient psychiatric hospitalization

– There was a reduction in inpatient psychiatric bed days for youth with SED from 5000 days in 1995 to under 500 days by end of 1997

• WM average utilization per child per month for inpatient care over the past 20

years has ranged from 1.5% to 3.5% of total expenditures – That equates today to pmpm of about $78 or less than one day of psychiatric hospital care (1216 current enrolled youth with SED).

• Child welfare has seen significant reduction in “failed foster placements” since

initiation of dedicated MUTT services. – Nearly 90% of youth seen by MUTT have been stabilized in their current foster care placement.

• Reduction in child and adolescent bed capacity in Milwaukee County

Outcomes Supporting MUTT Sustainability Over 20 Years (cont.)

• Average length of stay in psychiatric inpatient care for youth

managed through MUTT = 2.4 days

– versus average stays of nearly 70 days before MUTT assumed gate- keeper duties.

• Average response time on calls going into the community for

MUTT = 20 minutes.

• MUTT has received high consumer satisfaction per survey.
• Provides Crisis Prevention Institute (CPI) training to all

Milwaukee police officers.

THE MILWAUKEE MODEL: LESSONS LEARNED

Lessons Learned From a System of Care (SOC) Perspective

• Mobile response was the first component developed in
• ur SOC because it could have the most immediate

impact on reduction of inpatient hospital and other institutional care, allowing redirection of saved monies (“Gatekeeper Function”).

• Mobile Response, care coordination and stabilization

services should be integrated into SOC because they

• ften need to function together in concert with and as

part of the Child and Family Team

Lessons Learned From SOC Perspective (cont.)

• It has been more advantageous to coordinate and

link the children’s mobile response service with CW, JJ and schools than adult crisis service

• Critical to have an array of crisis stabilization services

(i.e. in-home stabilizers, crisis stabilization beds, etc.) available to care coordinators to support crisis plans and alternatives to out of home care.

• Need formal agreements with inpatient providers to

avoid longer term hospital stays

MOBILE RESPONSE AND STABILIZATION IN NEW JERSEY

Elizabeth Manley

Assistant Commissioner New Jersey Children’s System of Care

Children’s System of Care (formerly DCBHS) Division of Child Protection & Permanency (formerly DYFS) Division of Family & Community Partnerships (formerly DPCP)

Office of Adolescent Services

New Jersey Department of Children and Families

Commissioner

New Jersey System

Division on Women

Summary of Children’s Initiative Concept Paper

The Children’s Initiative concept operates on the following abiding principles:

• The system for delivering care to children must be restructured and

expanded.

• There should be a single point of entry and a common screening tool

for all troubled children.

• Greater emphasis must be placed on providing services to children in

the most natural setting, at home or in their communities, if possible.

• Families must play a more active role in planning for their children.
• Non-risk-based care and utilization management methodologies must

be used to coordinate financing and delivery of services.

At Home In School In the Community

Successfully living with their families and reducing the need for

• ut-of-home treatment settings.

Successfully attending the least restrictive and most appropriate school setting close to home. Successfully participating In the community and becoming independent, productive and law-abiding citizens.

Children’s System of Care Objectives

To Help Youth Succeed…

System of Care Values and Principles

Youth-Guided and Family-Driven Community Based Culturally/Linguistically Competent

Strength Based Unconditional Care Promoting Independence Family Involvement Collaborative Cost Effective Comprehensive Individualized Home, School & Community Based Team Based

Children’s System of Care History

1999

NJ wins a federal system

• f care grant that allowed

us to develop a system of care.

2000 - 2001

NJ restructures the funding system that serves children. Through Medicaid and the contracted system administrator, children no longer need to enter the child welfare system to receive behavioral health care services.

2006

The Department of Children and Families (DCF) becomes the first cabinet-level department exclusively dedicated to children and families.

2007 – 2012

The number of youth in

• ut-of-state behavioral

health care goes from more than 300 to three.*

July 2012

Intellectual/developmental disability (I/DD) services for youth and young adults under age 21 is transitioned from the Department of Human Services (DHS) Division of Developmental Disabilities to the DCF Children’s System of Care (CSOC).

May 2013

Unification of care management, under CMO, is completed statewide.

July 2013

Substance use treatment services for youth under age 18 is transitioned from DHS, Division of Mental Health and Addiction Services, to DCF/CSOC. *How did we do this? Careful individualized planning and the development of in-state options (based on research about what kids need) using resources that were previously going out of state.

December 2014

Integration of Physical and Behavioral Health is piloted in Bergen and Mercer County with expected Statewide rollout

July 2015

NJ wins a Federal SAMHSA Grant System of Care - Expansion and Sustainability

Overuse of Deep-End Services

Low Intensity Services Out of Home Out

• f

Home Intensive In-Community

• Wraparound – CMO
• Behavioral Assistance
• Intensive In-Community

Lower Intensity Services

• Outpatient
• Partial Care
• After School Programs
• Therapeutic Nursery

Client Case Placement

Language Is Important

Language Is Important

• Children, youth, young

adult

• Parents, caregivers
• Treatment
• Engagement
• Transition
• Missing
• Family Time

Language of CSOC

• Clients, Case,

Consumer

• Mom and Dad
• Placement
• Not Motivated
• Close, Terminate
• Runaway
• Home visits

Not the Language of CSOC

Key System Components

Contracted System Administrator

• PerformCare is the single portal for access to care

available 24/7/365

Care Management Organization

• Utilizes a wraparound model to serve youth and

families with complex needs

Mobile Response & Stabilization Services

• Crisis response and planning available 24/7/365

Family Support Organization

• Family-led support and advocacy for

parents/caregivers and youth

Key System Components

Intensive In-Community

• Flexible, multi-purpose, in-home/community clinical support for

parents/caregivers and youth with behavioral and emotional disturbances who are receiving care management, MRSS or out-of- home services

Out of Home

• Full continuum of treatment services based on clinical need

DD-IIH and Family Support Services

• Supports, services, resources and other assistance designed to

maintain and enhance the quality of life of a young person with intellectual/developmental disability and his or her family, including respite services and assistive technology

Substance Use Treatment Services

• Outpatient, out of home, detox treatment services (limited),

co-occurring services Traditional Services

• Partial Care, Partial Hospitalization, Inpatient and

Outpatient services

Case Management Census

89

Out of Home Census

90

Case Management Organization In Home/Out of Home

91

NJ Building In-State Capacity and Increasing Community Based Services

92

Mobile Response and Stabilization Services

Stayed in Current Living Situation 94% Did not stay in Current Living Situation 6%

9/1/2016 through 9/30/2016 ( n = 1,064 )

CSOC is Proportionally Serving More Youth Age 13 and Under

Integrating Services

NJ MRSS Mission and Goal

Mobile Response and Stabilization Services help children/ youth and their families who are experiencing an emotional or behavioral stressor by interrupting immediate crisis and ensuring youth and their families are safe. MRSS provides the support and skills necessary to return youth and families to typical functioning.

NJ MRSS Program Elements

• Youth and young adults under 18
• Young Adults involved with DCF under 21
• Parent/Caregiver consent
• Escalating emotional or behavioral needs
• Family defined crisis

What Is a Crisis?

A crisis occurs when:

• One’s sense of balance is disrupted
• Coping and problem solving skills that worked in

the past are not working

• Life functioning is disrupted
• Crisis is defined by the person/

family experiencing it!

Crisis Equals Opportunity

NJ MRSS Program Eligibility

–Clinical criteria –Special populations and system merge (Family Crisis Intervention Units) –Open for all NJ families

NJ MRSS Program Access

– Single point of access – 24/7 CSOC contracted systems administrator (CSA) – Clinical triage – Verbal consent – Warm line with local MRSS – Crisis intervention response

NJ MRSS Program Structure

– 24/7 community response – where you are, anywhere in NJ – 72 hour initial intervention – Up to 8 week stabilization period – Provider network – County based organization within the system of care

• Family support organization
• Care management organization
• Children’s interagency coordinating councils (CIACC)

NJ MRSS Program Additional Elements

• Local system collaboration

– CIACC and new relationships – Police departments – Pediatricians – School

• Training, certification and supervision
• Crisis assessment tool (CAT)

The Six Domains of the CAT

Risk Behaviors Behavioral/ Emotional Symptoms Life Domain Functioning Juvenile Justice Risk Child Protection Caregiver Needs & Strengths

Addition of Developmental, Medical/Physical and Substance Abuse Modules

NJ MRSS Program Response

• DE-ESCALATION - observing, interrupting and shifting

dynamics, education and skill introduction. You are the experts in your youth and family.

• ASSESSMENT – strengths, triggers, communication,

contexts (medical, mental health, trauma, development, patterns of behavior, collateral outreach, etc.)

• PLANNING – safety, crisis and transition, alternative

strategies, plan oversight/progress monitoring

NJ MRSS Program Response (cont.)

– Engagement of youth and family – System of care values/Wraparound principles – Coordination of supports and services – 3-2-1 contact – Linkage and connection – Family support and service – access through CSA – DD eligibility – Documentation

Individual Crisis Planning: Proactive Plan

• Youth and family vision
• Functional strengths of the youth and family
• Target behaviors and primary presenting needs
• Strength-based strategies
• Barriers to implementing strategies
• Additional unmet needs
• Youth diagnosis and medication if needed
• Services to be requested (if any)
• Resource/Support people and their roles

Establish consensus with youth and family on the plan

Stabilization Management

Active, Engaged, Ongoing Process: – Additional face to face meetings as needed – Family liaison and advocate – Active monitoring of progress toward outcomes – Resource referrals – Service delivery oversight – Transition planning – Progress notes and other documentation as needed

• Ongoing communication with family
• Collateral contacts

NJ MRSS Program Funding

• Presumptive eligibility
• Medicaid rehabilitation option
• State funding for youth not New Jersey family care

eligible

• Wrap/Flex funds to support non-Medicaid

reimbursable services

• Third party liability coordination

System Success

• Cost of Care for youth 2003 - $30,000 vs. Cost of Care for youth 2008 - $15,000
• Total federal revenue increased 5x, while state costs grew 2x (FY 08)

OTHER ACHIEVEMENTS AND LARGER SYSTEM OUTCOMES

• Fewer children in institutional care
• Fewer children accessing inpatient treatment
• Closure of state child psychiatric hospital and RTFs.
• Very few children in out-of-state facilities n = 3
• Children in out of home care have more intense needs than prior to system of care

development.

• Fewer youth in detention centers
• Youth entering system of care at younger age

For More Information

NJ’s Children’s System of Care www.state.nj.us/dcf PerformCare www.performcarenj.org

CONNECTICUT’S MOBILE CRISIS INTERVENTION SERVICE

Adora Harizaj, B.S

Project Coordinator Child Health & Development Institute of Connecticut

Tim Marshall, L.C.S.W.

Clinical Manager CT Department of Children and Families

Background

• A recent study using nationally representative data (Torio et al., 2015)
• Overall, youth hospitalizations for all conditions did not increase between

2006 and 2011

• Hospitalizations for mental health conditions increased by 50%
• Emergency department (ED) visits for mental health conditions increased

by 21%

• $11.6 billion spent on hospital visits for mental health
• Historically, high utilization and costs associated with “deep-end” treatment
• In 2000, CT legislation expanded access to home- and community-based

services and supports (including mobile crisis services)

• Subsequent data suggests shifting resources from deep-end to community-

based care; yet, there continues to be high utilization of EDs for behavioral health

Background (cont.)

• Why mobile crisis in Connecticut?
• High rates of ED use for behavioral health
• High utilization of inpatient and residential treatment
• Late 1990’s shift toward system of care, community-based treatment
• Mobile Crisis Implementation (mid 1990s to mid 2000s)
• Increasing dissatisfaction with EMPS service delivery into the mid-2000’s
• 50% mobility rates, limited mobile hours
• Variability in quality across funded sites
• Continued high rates of ED use, EMPS use remained flat
• Consumer and referrer complaints
• Model Re-Design and Re-Procurement (2008-2009)
• Model re-design based on national best practices
• Re-procurement of provider network
• New goals and benchmarks, accountability
• Political challenges

What are Mobile Crisis Intervention Services?

• Mobile Crisis Intervention Services (formerly known as Emergency Mobile Psychiatric

Services or EMPS)

• A team of trained mental health professionals who can respond immediately on-site, or

by phone, when a child is experiencing a mental health need or is in crisis

• Teams consist of: Site Director; MA-level licensed/eligible clinicians; psychiatric consult

time; family partners

• Funded by state grants (DCF) with third party reimbursement from Medicaid and

commercial insurers

• Who can receive Mobile Crisis?
• Anyone can call on behalf of a youth who is in crisis or has a mental health need
• A “crisis” is defined by the family
• Any child 18 or younger in Connecticut (19 year olds, if in school)
• Available regardless of system involvement, insurance, ability to pay
• Exclusions: Youth in Residential Treatment Centers, Sub-Acute Units, Inpatient

Hospitals

The Mobile Crisis Service System

• Mobile Crisis Provider Network
• Six primary contractors
• Fourteen total sites (subcontracts, satellites, statewide coverage)
• 170+ full time and part time/per diem employees
• Statewide Call Center
• Call triage; warm transfer to Mobile Crisis Intervention Services provider
• Clinical coverage during non-mobile hours, Mobile Crisis Intervention Services

follow-up during next available mobile hours

• Performance Improvement Center (MCIS-PIC)
• Web-based Data Collection and Entry
• Data Analysis, Reporting and Quality Improvement
• Standardized Training Curriculum
• Standardized Practice Development
• Evaluation Research and Ad Hoc Data Requests

Vanderploeg, J., Lu, J., Marshall, T., & Stevens, K. (Oct. 23, 2016). Mobile crisis services for children and families: Advancing a community-based model in Connecticut. Children and Youth Services Review, 71, 103-109. http://dx.doi.org/10.1016/j.childyouth.2016.10.034.

Accessing Mobile Crisis

• Mobile Crisis Mobile Hours

– 6am to 10pm, Mon-Fri – 1pm to 10pm, Sat/Sun/Holidays – Crisis clinician response during non-mobile hours, with Mobile Crisis

Intervention Services follow-up offered at next mobile hours

– Capacity to handle multiple calls simultaneously

• Key Provider Performance Benchmarks

– High volume: Reach your community – Be mobile: 90% or higher mobility – Respond quickly: 45 minutes (or less) for at least 80% of all mobile responses – All measured and reported transparently by the Mobile Crisis Intervention Services PIC

Accessing Mobile Crisis (cont.)

• Why provide a mobile response vs. telephone?

– Crisis situation and mobile response might be first system

introduction

– Making a face-to-face connection, assessing strengths and

needs in person

– Addresses access barriers that impact disadvantaged

populations

– Mobile response facilitates being a resource not just to the

family, but to the community

Mobile Crisis Providers

Available Services

• Mobile response to homes, schools, EDs, community locations
• Crisis stabilization
• Diversion from the ED, collaboration with ED, inpatient

hospitals, law enforcement intervention, schools

• Clinical assessment using standardized instruments
• Follow-up services for up to 45 days (and unlimited episodes of

care)

• Access to psychiatric evaluation and medication management
• Collaboration with families, schools, hospitals, other providers
• Referral and linkage to ongoing care as needed

Standardized Training

• Parents are paid co-trainers and members of

agency Quality Improvement teams

• Parents are also welcome to take part in the

in-house trainings Core Modules – 1 (4x/year) 1. Crisis Assessment, Planning and Intervention 2. Traumatic Stress and Trauma Informed Care 3. Emergency Certificate Training 4. Assessing Violence Risk in Children and Adolescents Core Modules – 2 (3x/year)

• 1. 21st Century Culturally Responsive Mental

Health Care

• 2. Disaster Behavioral Health Response Network

(DBHRN)

• 3. An Overview of Intellectual Disabilities and

Positive Behavioral Supports

• 4. Question, Persuade and Refer (QPR) (in-house

training)

• 5. Strengths-Based Crisis Planning
• 6. Columbia Suicide Severity Rating Scale (C-

SSRS) (Online training)

• 7. Adolescent Screening, Brief Intervention and

Referral to Treatment (A-SBIRT)(in-house training)

• 8. Autism Spectrum Disorder (added in FY2018)

Mobile Crisis Episodes of Care

• Phone Only

– 22% of all episodes

• Face to Face

– 44% of all episodes – 1 to 5 days – Streamlined assessment and intake process

• Stabilization and Follow-Up

– 34% of all episodes – Comprehensive standardized intake process – Assessment and outcome measures at intake and discharge – No limit on repeat episodes of care

Staffing

• 170+ full time and part time/per diem clinicians statewide
• Most Mobile Crisis teams housed within large community-based mental health

clinics with full service array

• Clinicians are typically Master level (MSW, LPC, or LMFT), licensed or license-

eligible clinicians

• .50 to 1.0 FTE Directors at each site (Master or Doctoral level)
• Each contract includes capacity for psychiatric consultation and medication

management

• Family partners used on some teams, primarily for parent engagement and

follow-up

• Team responses are preferred, but less likely to occur as volume has increased
• ver time
• Total Funding to Mobile Crisis Intervention Services

CLIENT CHARACTERISTICS, PERFORMANCE MEASURES AND OUTCOMES IN CONNECTICUT

Age

4.1% 11.9% 26.8% 33.3% 23.4% 0.4% <=5 6-8 9-12 13-15 16-18 19+ (N = 9,839)

Racial Background

0.6% 1.8% 23.0% 0.3% 61.4% 12.8%

American Indian/Alaska Native Asian Black/African American Native Hawaiian Pacific Islander White Other Race

(N = 9,354)

Note: Clients may self-identify more than one Race.

Ethnic Background

67.2% 1.4% 13.3% 0.1% 0.7% 17.3%

Non-Hispanic Origin Mexican, Mexican American, Chican Puerto Rican Cuban South or Central American Hispanic/Latino Origin

(N = 9,283)

Insurance Status

61.9% 30.0% 2.2% 1.6% 3.4% 0.2% 0.7% 0.0%

0.0% 10.0% 20.0% 30.0% 40.0% 50.0% 60.0% 70.0%

Husky A Private No Health Insurance Husky B Other Medicaid (non-HUSKY) Military Health Care Medicare

DCF (Child Welfare) Involvement

85.5% 6.2% 2.7% 1.2% 0.6% 1.2% 1.3% 0.3% 0.4% 0.4% 0.0% 0.1% 85.3% 7.0% 2.0% 0.9% 0.5% 1.3% 1.8% 0.3% 0.4% 0.3% 0.1%

0.0% 10.0% 20.0% 30.0% 40.0% 50.0% 60.0% 70.0% 80.0% 90.0%

Not DCF Child Protective Services - In Home Child Protective Services - Out of Home Voluntary Services Program Termination of Parental Rights Family with Service Needs (FWSN) - In Home Family Assessment Response Not DCF - On Probation Not DCF - Other Court Involved Family with Service Needs (FWSN) - Out of Home Juvenile Justice (delinquency) commitment Dual Commitment (Juvenile Justice and Child Protective Services)

DCF Status Intake DCF Status Discharge

Out of Home Placement

5% 5% 4% 2% 4% 7% 5% 1% 2% 2% 1% 2% 3% 2%

0% 1% 2% 3% 4% 5% 6% 7% 8%

Central Eastern Hartford New Haven Southwestern Western Statewide

Out of home 1 or more times in lifetime Out of home 1 or more times in 6 months prior

SED Status

82% 72% 84% 81% 84% 43% 76%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Juvenile Justice Involvement

*Arrested refers to any arrest, regardless of whether it resulted in formal arraignment or adjudication 3.6% 4.1% 4.0% 3.4% 3.3% 7.6% 4.3% 2.7% 1.3% 0.5% 2.8% 1.2% 2.2% 1.7%

0.0% 1.0% 2.0% 3.0% 4.0% 5.0% 6.0% 7.0% 8.0%

Central Eastern Hartford New Haven Southwestern Western Statewide

Arrested in the 6 months prior Arrested during the episode of care

Presenting Problems

30% 43% 26% 29% 23% 24% 29% 24% 24% 27% 26% 23% 30% 26% 13% 4% 15% 13% 18% 14% 13% 7% 3% 5% 5% 6% 6% 5% 8% 4% 6% 9% 9% 8% 7% 6% 14% 7% 7% 3% 7% 7% 11% 9% 16% 11% 17% 12% 13%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Harm/Risk of Harm to Self Disruptive Behavior Depression Family Conflict Anxiety Harm/Risk of Harm to Others Other (Not in top 6)

Trauma Exposure

57% 69% 57% 70% 55% 64% 61%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Referral Sources

39.6% 41.8% 2.5% 8.7% 0.3% 1.5% 0.6% 1.5% 3.7%

Self/Family School Other community provider Emergency Department (ED) Probation/Court

• Dept. Children & Families

Foster Parent Police Other

Referrals From Emergency Departments

12.0% 11.2% 10.1% 10.6% 9.2% 8.6% 9.0%

0.0% 2.0% 4.0% 6.0% 8.0% 10.0% 12.0% 14.0%

FY 2011 FY 2012 FY 2013 FY 2014 FY 2015 FY 2016 FY 2017

Statewide Call and Episode Volume (Mobile Crisis FY2011 – FY2017)

9,457 10,459 11,105 12,376 12,478 12,419 13,488 2,808 3,330 4,469 5,626 4166 4,370 4,533 5,000 10,000 15,000 20,000 FY 2011 FY 2012 FY 2013 FY 2014 FY 2015 FY 2016 FY 2017 211 Only Mobile Crisis Episode

Statewide Mobile Crisis Utilization Per 1,000: FY2017 (By Service Area)

17.57 18.01 23.37 15.38 11.50 14.06 16.52

0.00 5.00 10.00 15.00 20.00 25.00

Central Eastern Hartford New Haven Southwestern Western Statewide

Statewide Mobility Rates

Goal = 90%

50.0% 90.3% 92.5% 91.9% 91.7% 92.4% 92.5% 93.0%

0% 20% 40% 60% 80% 100%

Service Area Mobility Rates (FY2017)

Goal = 90%

90.9% 93.4% 91.9% 93.7% 93.8% 95.4% 93.0% 0.0% 10.0% 20.0% 30.0% 40.0% 50.0% 60.0% 70.0% 80.0% 90.0% 100.0%

Statewide Response Times Under 45 Minutes (Mobile Crisis Episodes FY2010 – FY2017)

Goal = 80%

62% 86% 85% 88% 87% 89% 89% 88%

0% 20% 40% 60% 80% 100% FY 2010 FY 2011 FY 2012 FY 2013 FY 2014 FY 2015 FY 2016 FY 2017

Service Area Response Times Under 45 Minutes (FY2017)

Goal = 80%

90% 93% 85% 92% 93% 81% 88%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Central (1049) Eastern (991) Hartford (1845) New Haven (1058) Southwestern (1089) Western (1228) Statewide (7260)

Clinical Outcomes (FY2017)

• Mobile Crisis is a brief intervention (average length of stay is under 20 days)
• Getting parent-completed discharge measures has proven increasingly challenging
• All changes are statistically significant
• SAMHSA Service to Science outcome measure development

Table 1. Statewide Ohio Scale Scores (based on paired intake and discharge scores) N Mean (intake) Mean (discharge) t-score Sig. % Clinically Meaningful Change

Parent Functioning Score

236

39.53 40.92 1.91 P<0.1 11.4% Worker Functioning Score

3025

43.84 45.66 11.46 P<0.01 8.4% Parent Problem Severity Score

235

24.58 20.15

• 7.21

P<0.01 18.7% Worker Problem Severity Score

3005

27.90 25.27

• 16.87

P<0.01 10.2%

Service Referrals at Discharge

45.0% 20.5% 11.1% 6.5% 3.9% 3.3% 3.6% 1.6% 2.4% 1.4% 0.3% 0.5%

0.0% 5.0% 10.0% 15.0% 20.0% 25.0% 30.0% 35.0% 40.0% 45.0% 50.0%

Outpatient Services (5920) None (2696) Intensive Outpatient Services (1459) Other: Community-Based (850) Inpatient Hospital Care (510) Intensive In-Home Services (436) Partial Hospital Program (470) Extended Day Program (213) Care Coordination (321) Other: Out-of-Home (182) Group Home (39) Residential Treatment (63)

Cost vs. Cost Savings

• Costs for developing important component of a comprehensive system of

care

• There have been only a few studies of the cost offsets associated with

mobile crisis--possible cost savings exist in the following areas: – Diversion from hospital-based emergency services

• Emergency department (ED)
• Inpatient hospitalization

– Diversion from Highest Levels of Care in BH System

• Psychiatric residential, group homes

– Diversion from arrest/incarceration – Depending on eligibility, savings to public system (Medicaid) as well as commercial insurance providers

Average Cost of Episodes of Care: Inpatient vs. Mobile Crisis

$11,439 $793

$- $2,000 $4,000 $6,000 $8,000 $10,000 $12,000 $14,000 Inpatient Mobile Crisis

Estimated Medicaid Cost Savings

EMERGENCY DEPARTMENT (ED) USAGE OF MOBILE CRISIS FOR INPATIENT DIVERSION

• EDs referred to Mobile Crisis 1,167 times in FY 2017
• ED staff coded 449 referrals as “inpatient diversions”
• Approximately 62% (278) of those were for youth enrolled in Medicaid
• 278 inpatient diversions X $10,646 (avg. cost savings between inpatient and

Mobile Crisis episode) = $2,959,588

• Other possible savings: ED diversion; arrest/incarceration diversion; higher level
• f care diversion; savings to commercial insurance

Lessons Learned

• Develop contracts with key model specifications and performance expectations
• Institute culture of “crisis defined by caller”
• Institute culture of “JUST GO!”
• Single statewide call center: Easier for families; enhances access
• Standardized practice model for all sites
• Promote access, quality and outcomes using performance data analysis and

reporting, workforce development, data transparency

• Mobile crisis creates an important linkage to EDs

– Divert from ED (by responding to schools, homes) – Help connect youth and families in ED back to the community

• Programs are kept fiscally viable by combining grant funds and third party

reimbursement

• Adapt/leverage the model to link and integrate with other services/systems

(e.g., School-Based Diversion Initiative (SBDI))

Next Steps and Future Directions

• Complete MOAs with schools; continue outreach
• Continue Mobile Crisis diversion from EDs
• Build out full array of crisis-oriented services
• Alternative behavioral health crisis assessment center
• Short Term Family Integrated Treatment Program (S-FIT) beds
• Mobile Crisis serves gatekeeping function and triages to three options
• Inpatient hospitalization
• Crisis stabilization units
• Emergency respite
• Achieved March 1: S-FIT
• Complete study of Mobile Crisis and ED utilization among Medicaid-enrolled youth
• Continued outreach to police (e.g., REACT)
• Statewide SBDI expansion
• Implementing SBDI in 18 schools and looking to expand further to address arrest

diversion, discipline, chronic absenteeism

Contact Information

www.empsct.org

Tim Marshall, L.C.S.W. Clinical Manager Department of Children and Families Tim.marshall@ct.gov (860) 550-6531 Adora Harizaj, B.S Project Coordinator Child Health and Development Institute (CHDI) harizaj@uchc.edu (860) 679-6549